术前动脉栓塞术及手术间隔时间对直径≥10 cm肾细胞癌患者疗效及安全性的影响

Influence of preoperative arterial embolization and operation interval on clinical efficacy and safety of renal cell carcinoma patients with diameter ≥ 10 cm

目的:探讨术前动脉栓塞术及手术间隔时间对直径≥10 cm肾细胞癌患者疗效及安全性的影响。方法:选取我院2012年1月至2018年7月收治最大径≥10 cm肾细胞癌患者共79例,其中20例行术前动脉栓塞术治疗(观察组),其余59例直接行根治手术或减瘤手术治疗(对照组),比较两组手术时间、术后Hb下降值、围手术期输血比例、总住院时间、手术住院费用、手术方案相关指标及术后严重并发症发生率;同时记录并比较手术间隔时间≥36 h和<36 h患者围手术期临床指标水平。结果:术前动脉栓塞与否:观察组手术时间、术后Hb下降值及围手术期输血比例显著少于对照组(P<0.05);观察组总住院时间和总治疗费用均显著多于对照组(P<0.05);两组手术方案相关指标和术后严重并发症发生率比较差异无统计学意义(P>0.05)。手术间隔时间:手术间隔时间<36 h组手术时间显著长于手术间隔时间≥36 h组(P<0.05);手术间隔时间<36 h组总住院时间、病理坏死率、栓塞后疼痛及发热发生率均显著少于手术间隔时间≥36 h组(P<0.05);手术间隔时间≥36 h和<36 h患者术后Hb下降值、总治疗费用、手术方式及栓塞后呕吐发生率比较差异无统计学意义(P>0.05)。结论:直径≥10 cm肾细胞癌患者行术前动脉栓塞术治疗可有效缩短手术用时,降低术中出血量,但可能增加住院时间和治疗费用;而栓塞术后36 h内行手术治疗在加快术后康复进程、降低栓塞后综合征发生风险方面具有优势,而延长手术间隔时间则有助于提高病理坏死率、缩短手术用时。

Objective:To investigate the influence of preoperative arterial embolization and operation interval on clinical efficacy and safety of renal cell carcinoma patients with diameter ≥ 10 cm.Methods:79 renal cell carcinoma patients with diameter ≥ 10 cm were chosen in the period from January 2012 to July 2018 in our hospital and randomly divided into both groups including control group(59 patients)without preoperative arterial embolization and observation group(20 patients)with preoperative arterial embolization,and the operation time,decreased value of Hb after operation,proportion of blood transfusion during perioperative period,total hospitalization time,hospitalization cost after operation,related indexes of operation scheme and incidence of serious complications after operation of both groups were compared.Meanwhile,the perioperative clinical indexes of patients with operation interval for≥36 h and <36 h were recorded and compared.Results:The operation time, decreased value of Hb after operation, proportion of blood transfusion during perioperative period of observation group were significantly less than control group( P <0. 05). The total hospitalization time and total treatment cost of observation group were significantly more than control group( P < 0. 05). There was no significant difference in the related indexes of operation scheme and incidence of serious complications after operation between the two groups( P > 0. 05). The operation time of patients with operation interval for < 36 h were significantly longer than operation interval for≥36 h( P < 0. 05). The total hospitalization time,pathological necrosis rate,post-embolization pain and fever incidence of patients with operation interval for < 36 h were significantly less than operation interval for≥36 h( P < 0. 05). There was no significant difference in the decreased value of Hb after operation,total treatment cost,surgical procedures and incidence of vomiting after embolization between patients with operation interval for≥36 h and < 36 h( P > 0. 05). Conclusion: Preoperative arterial embolization and operation interval in the treatment of renal cell carcinoma patients with diameter≥10 cm can efficiently shorten operation time and reduce intraoperative bleeding,and also may increase hospitalization time and treatment cost. Patients undergoing operation within 36 hours after embolization has advantages in speeding up the recovery process and reducing the post-embolism syndrome risk,while prolonging the operation interval can be helpful to improve the pathological necrosis rate and shorten the operation time.